For the Concord Monitor
A serious threat to seniors and those with disabilities is being ignored in the debate over repealing the Affordable Care Act.We must not forget that the Medicaid program dates back to 1965, not the ACA expansion for the working poor. This half-century-old safety net is responsible for more than three-fifths of all nursing home patients, and it, too, is imperiled. The incoming secretary of federal Health and Human Services, Congressman Tom Price, a Georgia Republican, favors rationing Medicaid through “block grants.” Presently, state Medicaid spending is matched by the federal government in an income-based formula. Poor states get more, affluent states get less. A block grant effectively freezes the federal contribution for each state, leaving states with no incentive to improve Medicaid funding.
Block grants would injure the vulnerable in all states, but particularly states like New Hampshire, where the federal participation in Medicaid spending is only 50 percent. By freezing the federal contribution, block grants would forever advantage states with higher matching rates, such as Price’s Georgia, where the federal government pays 67.9 percent of all Medicaid costs.In New Hampshire, the nation’s second-oldest state, the state’s payment shortfall has exacerbated a crisis in staff recruitment and retention. This is a state that somehow manages to even shortchange, by hundreds of thousands of dollars, the care costs of a 40-bed facility for Catholic nuns. Arguably it values prison care more – the recent 15 percent wage increase for prison nurses is more than twice what the increase in Medicaid rates has been for the past seven years. Yet a compassionate public wants improved long-term care funding. A post-election poll of 800 New Hampshire voters found a plurality (43 percent) actually chose long-term care funding as their top legislative priority, and more than three-quarters (76 percent) of voters felt Medicaid costs should be fully reimbursed. Unlike the federal government, states have to balance their budgets. While no states fund Medicaid generously under the best of circumstances, most cut it in economic downturns.
(Brendan Williams is the president and CEO of the New Hampshire Health Care Association.)